Budesonide Extended Release for Ulcerative Colitis

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Question(s)

What is the clinical effectiveness of budesonide delayed and extended release for the induction of remission in patients with active mild to moderate UC?
What is the clinical effectiveness of budesonide delayed and extended release for the induction of remission in patients with active moderate to severe UC?
What is the cost-effectiveness of budesonide delayed and extended release for the induction of remission in patients with active mild to moderate UC?
What is the cost-effectiveness of budesonide delayed and extended release for the induction of remission in patients with active moderate to severe UC?
What are the evidence-based guidelines regarding the use of budesonide delayed and extended release for the induction of remission in patients with active mild, moderate, or severe UC?

Key Message

In 2017, the Canada's Drug Agency Canadian Drug Expert Committee recommended that budesonide extended release (with multi-matrix system) not be reimbursed for the induction of remission in patients with active mild to moderate ulcerative colitis based on limitations in the evidence at that time. The limited primary clinical evidence (i.e., 1 randomized controlled trial) published since the literature searches conducted for the previous Canada's Drug Agency Reimbursement Review corroborates the clinical findings of that report. The evidence demonstrates that budesonide extended release is more effective for inducing remission in patients with mild to moderate ulcerative colitis compared to placebo. No new clinical evidence was identified describing head-to-head comparisons of budesonide extended release with active therapies. Indirect comparative evidence between budesonide extended release and other active therapies suggests minimal or no difference in remission, clinical response, or adverse events. Cost-effectiveness evidence from 1 study conducted in the Netherlands indicates that budesonide extended release is a more effective and less costly second-line therapy versus aggregated comparators for patients with mild to moderate ulcerative colitis. Evidence-based recommendations support the use of budesonide extended release for patients with mild to moderate ulcerative colitis who have not responded to 5-ASAs. No clinical or cost-effectiveness evidence or evidence-based recommendations were found describing the use of budesonide extended release in patients with moderate to severe ulcerative colitis.

Last Updated : October 6, 2023

Drug Shortages in Canada — Expert Panel

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Drug shortages pose significant challenges to policy-makers and health care providers in Canada. This research initiative aims to identify high-priority drugs at risk of a drug shortage. An expert panel comprising stakeholders from various sectors will be developed to inform a drug shortage risk prediction model that combines both clinical importance and supply chain risks.

Last Updated : March 4, 2025

Opioid Analgesics to Treat Chronic Noncancer Pain among Patients Prescribed Opioid Agonist Therapy or With Opioid Use Disorder

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There is uncertainty related to the prescribing of opioid analgesics to treat chronic pain in adult patients with opioid use disorder (OUD) or a history of OUD. Guidance is required on the optimal prescribing of opioid analgesics to ensure that patients are benefiting from treatment with minimal harm. This systematic review examined 5 observational studies on the safety of opioid analgesics alone or with opioid agonist therapy for chronic pain in patients with OUD or a history of OUD.

Last Updated : July 23, 2024

Healthy Aging Interventions, Programs, and Initiatives: An Environmental Scan

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Summary

Canadians are generally living longer in good health than previous generations. However, there is still a high risk of frailty among community-dwelling older adults. With the older adult population steadily rising in Canada, it is important that effective interventions, programs, and initiatives are developed to support the healthy aging of older adults in the community.

Last Updated : July 10, 2020

Direct-Acting Antivirals for Pediatric Chronic Hepatitis C Virus Infection

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Question(s)

What is the clinical effectiveness of GLE-PIB for the treatment of chronic HCV infection in pediatric patients?
What is the clinical effectiveness of SOF-VEL for the treatment of chronic HCV infection in pediatric patients?
What is the cost-effectiveness of GLE-PIB for the treatment of chronic HCV infection in pediatric patients?
What is the cost-effectiveness of SOF-VEL for the treatment of chronic HCV infection in pediatric patients?

Key Message

Clinical evidence showed that treatment with glecaprevir-pibrentasvir for children and adolescents with chronic hepatitis C virus infection was efficacious with an overall sustained virologic response 12 weeks after treatment near 100%. Glecaprevir-pibrentasvir treatment was well-tolerated as there were no serious adverse events or adverse events leading to treatment discontinuation. Most adverse events were mild. We did not find any studies that evaluated the cost-effectiveness of glecaprevir-pibrentasvir for the treatment of chronic hepatitis C virus infection in pediatric patients. We did not find any peer-reviewed studies that evaluated the clinical effectiveness of sofosbuvir-velpatasvir for the treatment of chronic hepatitis C virus infection in pediatric patients. Unpublished data in a conference abstract and clinical trial registry suggest effectiveness of sofosbuvir-velpatasvir, but the findings should be interpreted with cautions. We did not find any studies that evaluated the cost-effectiveness of sofosbuvir-velpatasvir for the treatment of chronic hepatitis C virus infection in pediatric patients.

Last Updated : September 20, 2023

Midline and Extended Dwell Catheters for IV Antibiotics

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Question(s)

What is the clinical effectiveness of a midline catheter versus and an extended dwell catheter for delivering IV peripherally compatible antibiotics in adults?
What are the evidence-based guidelines regarding midline and extended dwell catheters for delivering IV peripherally compatible antibiotics in adults?

Key Message

Midline catheters may be associated with longer uncomplicated indwelling time and a lower overall risk of catheter-related complications than extended dwell catheters. The rates of catheter-related complications were low across different peripheral catheter types. Midline catheters may have a lower proportion of catheter-related bloodstream infections, drug leakage from the exit site, and complete catheter occlusion, but a higher proportion of catheter-related thrombosis events compared with extended dwell catheters. The findings were derived from 1 retrospective cohort study with imbalanced baseline characteristics of patients, and the limitations of the study may have favoured midline catheters; future studies are needed to confirm our findings. We did not find any systematic reviews, health technology assessments, randomized controlled trials, or evidence-based guidelines that met our inclusion criteria.

Last Updated : September 18, 2023

Non-Sterile Glove Use

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Question(s)

What is the clinical effectiveness of non-use versus use of nonsterile gloves for individuals receiving inpatient care considered at low risk of infection transmission?
What are the evidence-based guidelines regarding the use of nonsterile gloves for individuals receiving inpatient care considered at low risk of infection transmission?

Key Message

· In acute care settings with low-risk of infection transmission, discontinuing contact precautions (i.e., gloves and gown) may result in similar rates of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and may lower the risk of hospital-acquired vancomycin-resistant enterococci (VRE), compared to scenarios in which such precautions were employed.· Rates of late-onset infections in a neonatal intensive care unit were similar when standard infection control precautions were used compared with universal glove use.· Two guidelines recommend that nonsterile gloves should be worn for nonsterile procedures when it is anticipated that there will be contact with blood, body fluids, non-intact skin, mucous membranes, lesions, or hazardous drugs and chemicals; for environmental cleaning; and when contact precautions for infection control are in effect.

Last Updated : September 15, 2023

Somatropin for Short Stature

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Question(s)

What are the evidence-based guidelines regarding the use of growth hormone therapy for children with Short Stature Secondary to Small for Gestational Age?
What are the evidence-based guidelines regarding the use of growth hormone therapy for children with Idiopathic Short Stature?

Key Message

· For children with short stature who were born small for gestational age, 1 guideline suggests increasing human growth hormone dose when treatment response is unsatisfactory, while aiming for normal insulin-like growth factor 1 levels. · For children with idiopathic short stature, 1 guideline recommends against the routine use of growth hormone. It suggests initiating growth hormone therapy on a case-by-case basis, with a starting dose ranging from 0.24 mg/kg/week to 0.47 mg/kg/week, as well as conducting an assessment 12 months after initiation to optimize dosage. · The development of recommendations from guidelines included in this report was challenged by limited relevant evidence, as well as heterogeneity of growth hormone dose and frequency and treatment response found in available literature. Future guidelines should also consider patient perspectives, resource implications, and the facilitators of and barriers to therapy within the context of health care systems in Canada.

Last Updated : September 15, 2023

Timing of Ventilator Circuit Tubing Replacement

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Question(s)

What is the clinical effectiveness of different fixed or nonfixed intervals for timing ventilator circuit tubing replacements for patients with mechanical ventilation?
What are the evidence-based guidelines regarding ventilator circuit replacement for patients with mechanical ventilation?

Key Message

In adult patients with mechanical ventilation, more frequent ventilator circuit tubing replacement may increase the odds of ventilator-associated pneumonia, but the findings are imprecise. In pediatric patients with mechanical ventilation, more frequent and less frequent intervals of ventilator circuit tubing replacement may result in similar a risk of ventilator-associated pneumonia, all-cause mortality, and ventilator-associated pneumonia mortality, and similar durations of mechanical ventilation and hospital stay. For preterm neonates, children, and adult patients, it is recommended to replace the ventilator circuit tubing if it is visibly soiled, not functioning properly, or as recommended in the manufacturer's instructions. We did not find any guidelines about fixed versus nonfixed ventilator circuit tubing replacement.

Last Updated : September 8, 2023

Association Between Opioid Use and the Development of Diverticulitis

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Opioids are commonly used to treat severe pain but can cause constipation. One important clinical question is whether they increase the risk of diverticulitis, an illness caused by the inflammation or infection of the small pouches in the colon.

The overall objective of this study was to evaluate whether short-term and long-term opioid use is associated with an increased risk of diverticulitis in patients treated with opioids for pain after surgery, trauma, dental procedures, or other pain indications.

Last Updated : February 10, 2025